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Pub 100-02 Medicare Benefit Policy

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Pub 100-02 Medicare Benefit Policy Department of Health & Human CMS Manual System Services (DHHS) Pub 100-02 Medicare Benefit Centers for Medicare & Medicaid Policy Services (CMS) Transmittal 111 Date: September 25, 2009 Change Request 6005 SUBJECT: Comprehensive Outpatient Rehabilitation Facility (CORF) Services I. SUMMARY OF CHANGES: Chapter 12 is revised based on the changes made in the 2008 Medicare Physician Fee Schedule regulation. Defines that all CORF services must be directly related to the physical therapy (PT), occupational therapy (OT), speech language pathology (SLP) or respiratory therapy (RT) rehabilitation plan of treatment. This Change Request (CR) clarifies that the physician must wholly develop the RT rehabilitation plan of treatment, only a respiratory therapist (not a respiratory technician) can provide respiratory therapy service, which does not include diagnostic or physiological monitoring services. This CR clarifies that social and psychological services (not mental health services) are core CORF services, which must be reasonable and medically necessary and directly related to the PT, OT, SLP, or RT therapy plan of treatment. This CR clarifies that incident-to physician services cannot be provided in a CORF. New / Revised Material Effective Date: July 7, 2008 Implementation Date: October 26, 2009 Disclaimer for manual changes only: The revision date and transmittal number apply only to red italicized material. Any other material was previously published and remains unchanged. However, if this revision contains a table of contents, you will receive the new/revised information only, and not the entire table of contents. II. CHANGES IN MANUAL INSTRUCTIONS: (N/A if manual is not updated) R=REVISED, N=NEW, D=DELETED R/N/D CHAPTER/SECTION/SUBSECTION/TITLE R 12/Table Of Contents R 12/10/Comprehensive Outpatient Rehabilitation Facility (CORF) Services Provided by Medicare R 12/20/20.1/Required Services R 12/20/20.2/Optional CORF Services R 12/30//Rules for Provision of Services N 12/30/30.1/Rules for Payment of CORF Services R 12/40/40.1/Physician Services R 12/40/40.2/Physical Therapy Services R 12/40/40.3/Occupational Therapy Services R 12/40/40.4/Speech-Language Pathology Services R 12/40/40.5/Respiratory Therapy Services R 12/40/40.6/Prosthetic and Orthotic Devices and Supplies R 12/40/40.7/Social and/or Psychological Services R 12/40/40.8/Nursing Services R 12/40/40.9/Drugs and Biologicals R 12/40/40.10/Home Environment Evaluation N 12/40/40.11/Vaccines D 12/50/Outpatient Mental Health Treatment Limitation D 12/50/50.1/Outpatient Mental Health Limit Not Applicable for Hospital Inpatients D 12/50/50.2/Disorders Subject to Outpatient Mental Health Limitation D 12/50/50.3/Diagnostic Services D 12/50/50.4/Application of Mental Health Limitation D 12/50/50.5/Computation of Limitation III. FUNDING: SECTION A: For Fiscal Intermediaries and Carriers: No additional funding will be provided by CMS; contractor activities are to be carried out within their operating budgets. SECTION B: For Medicare Administrative Contractors (MACs): The Medicare Administrative Contractor is hereby advised that this constitutes technical direction as defined in your contract. CMS does not construe this as a change to the MAC Statement of Work. The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the contracting officer. If the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the contracting officer, in writing or by e-mail, and request formal directions regarding continued performance requirements. IV. ATTACHMENTS: Business Requirements Manual Instruction *Unless otherwise specified, the effective date is the date of service. Attachment - Business Requirements Pub. 100-02 Transmittal: 111 Date: September 25, 2009 Change Request: 6005 SUBJECT: Comprehensive Outpatient Rehabilitation Facility (CORF) Services Effective Date: July 7, 2008 Implementation Date: October 26, 2009 I. GENERAL INFORMATION A. Background: Pub. 100-02, Medicare Benefit Policy Manual, Chapter 12, Comprehensive Outpatient Rehabilitation Facility (CORF) Coverage, is amended to clarify general requirements, covered and non-covered services, provisions of services, and specific CORF services. B. Policy: The purpose of a CORF is to permit the beneficiary to receive multidisciplinary rehabilitation services at a single location in a coordinated fashion. Section 1861(cc) of the Social Security Act specifies that no service may be covered as a CORF service if it would not be covered as an inpatient hospital service if provided to a hospital patient. This does not mean that the beneficiary must require a hospital level of care or meet other requirements unique to hospital care. This provision merely requires that the service, if otherwise covered, would be covered if provided in a hospital. The requirement for CORF outpatient mental health treatment limitation is deleted. II. BUSINESS REQUIREMENTS TABLE Number Requirement Responsibility (place an “X” in each applicable column) A D F C R Shared-System OTHER / M I A H Maintainers B E R H F M V C R I I C M W M M I S S S F A A E S C C R 6005.1 CORF services shall be covered only if they relate X XX directly to the rehabilitation of injured, disabled, or sick patients. 6005.2 CORF requirements shall define that physical therapy X XX (PT), occupational therapy (OT), and speech-language pathology (SLP) services provided in the patient’s home shall be covered as CORF services unless such services are covered under the Medicare home health benefit. 6005.3 The patient shall be present during the home environment X XX evaluation performed by the PT, OT or SLP, as appropriate, because the patient’s presence is necessary to fully evaluate the potential impact of the home situation on the patient’s rehabilitation goals. 6005.4 CORF services shall not include the provision of X XX hyperbaric oxygen services, infusion therapy services, or diagnostic sleep studies because they do not meet the definition of CORF services nor do they relate to the rehabilitation plan of treatment. Number Requirement Responsibility (place an “X” in each applicable column) A D F C R Shared-System OTHER / M I A H Maintainers B E R H F M V C R I I C M W M M I S S S F A A E S C C R 6005.5 CORF physicians’ services shall be those professional X XX services performed by physicians that are administrative in nature, such as consultation with, and medical supervision of non-physician staff, patient case review conferences, utilization review, and the review of the therapy/pathology plan of treatment, as appropriate. 6005.6 Social and psychological services shall be covered only if X XX they are provided under the rehabilitation plan of treatment and relate directly to the rehabilitation of the patient. They shall include only those services that address the patient’s response and adjustment to the rehabilitation treatment plan, rate of improvement and progress towards the rehabilitation goals, or other services as they directly relate to the PT, OT, SLP, or respiratory rehabilitation therapy plan of treatment and do not include services for mental health diagnosis. 6005.7 Respiratory therapy services shall be only those services X XX that can be appropriately provided to CORF patients by a respiratory therapist under a physician-established respiratory therapy rehabilitation plan of treatment in accordance with current medical and clinical standards. 6005.7.1 Services performed by a respiratory therapy technician or X XX an entry-level respiratory therapist shall not be covered because the current medical standards for skilled respiratory therapy services provided to patients in the CORF setting require the educational requirements possessed by advanced level respiratory therapists. 6005.8 Payment for DME, prosthetics, orthotics, and supplies X XX (DMEPOS) shall be determined under the DMEPOS competitive bidding program as a single payment amount. 6005.9 The payment basis for CORF services shall be 80 percent X XX of the lesser of: (1) the actual charge for the services or (2) the physician fee schedule (PFS) amount for the service when the PFS establishes a payment amount for such service. Payment for CORF services under the PFS shall be made for PT, OT, SLP, and respiratory therapy services, as well as the related nursing and social and psychological services. 6005.10 General supervision shall require initial direction and X XX periodic participation of the actual rehabilitation therapy. However, the supervising therapist need not always be physically present or on the premises when the assistant is providing the services. 6005.11 CORF nursing services that relate to the rehabilitation X XX plan of treatment shall be provided by a registered nurse, Number Requirement Responsibility (place an “X” in each applicable column) A D F C R Shared-System OTHER / M I A H Maintainers B E R H F M V C R I I C M W M M I S S S F A A E S C C R rather than a licensed practical nurse. 6005.12 There are no drugs and biologicals currently identified as X XX appropriate for inclusion in the therapy rehabilitation plan of treatment. CORFs may not submit claims for drugs and biologicals. 6005.13 A CORF shall provide pneumococcal, influenza, and X XX hepatitis B vaccines to its patients if the facility is “primarily engaged in providing skilled comprehensive services that relate directly to the rehabilitation of injured, disabled, or sick persons” if a physician orders it. III. PROVIDER EDUCATION TABLE Number Requirement Responsibility (place an “X” in each applicable column) A D F C R Shared-System OTHER / M I A H Maintainers B E R H F M V C R I I C M W M M I S S S F A A E S C C R 6005.1 A provider education article related to this instruction will X XX 4 be available at http://www.cms.hhs.gov/MLNMattersArticles/ shortly after the CR is released.
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